Healthcare Provider Details

I. General information

NPI: 1821269929
Provider Name (Legal Business Name): RONALD A VIERK MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CHESTER BLVD
RICHMOND IN
47374-1213
US

IV. Provider business mailing address

1526 HUNTERS POINTE DR
RICHMOND IN
47374-7924
US

V. Phone/Fax

Practice location:
  • Phone: 765-966-1945
  • Fax:
Mailing address:
  • Phone: 765-966-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01031317B
License Number StateIN

VIII. Authorized Official

Name: DR. RONALD A VIERK
Title or Position: OWNER
Credential: M.D.
Phone: 765-966-1195